Provider Demographics
NPI:1316826027
Name:PEREZ GONZALEZ, ANA DEISY
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:DEISY
Last Name:PEREZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 ARLETTE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4902
Mailing Address - Country:US
Mailing Address - Phone:561-524-8258
Mailing Address - Fax:
Practice Address - Street 1:7971 RIVIERA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6447
Practice Address - Country:US
Practice Address - Phone:786-508-3245
Practice Address - Fax:561-634-2814
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-462020106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician